Pulmonology Pulmonology
Rev Port Pneumol 2007;13:71-81 - Vol. 13 Num.1 DOI: 10.1016/S0873-2159(15)30338-X
Artigo de Revisão / Revision Article
Derivação pericardioperitoneal no tratamento de derrames pericárdicos em doentes neoplásicos
Pericardioperitoneal shunt in the treatment of pericardial effusions in neoplasic patients
Nuno Cortesão1,, Ana Figueiredo2, Fernando Barata3, António Correia de Matos4, Carlos Janelas4
1 Interno Complementar de Pneumologia
2 Assistente de Pneumologia
3 Assistente Graduado de Pneumologia – Serviço de Pneumologia do Centro Hospitalar de Coimbra. Director: Dr. Jorge Pires.
4 Chefe de Serviço – Sector de Cirurgia Torácica do Centro Hospitalar de Coimbra. Director: Dr. Carlos Janelas.
Received 22 September 2005, Accepted 20 October 2006
Resumo

Os derrames pericárdicos que surgem num contexto neoplásico são frequentes e apresentam dificuldades de diagnóstico e tratamento. Apesar de surgirem em doentes com neoplasia, 50% destes derrames têm uma etiologia benigna; surgem por mecanismos paralelos, indirectamente relacionados com o tumor. Os restantes (derrames pericárdicos neoplásicos – DPN) resultam do atingimento tumoral das estruturas peri ou epicárdicas e assumem, por si só, um pior prognóstico. As opções de tratamento disponíveis são várias, mas a ausência de normas orientadoras da sua aplicação tornam difícil avaliar perfis de rentabilidade, eficácia e segurança. A derivação pericardioperitoneal (DPP) é um método cirúrgico de drenagem da cavidade pericárdica que se tem demonstrado muito útil em DPN. No CHC, esta técnica é efectuada com o auxílio de toracoscopia videoassistida (VATS). Nos últimos 8 anos, foram submetidos a esta modalidade terapêutica 18 doentes com DPN. A técnica demonstrou ser segura, eficaz e com baixa morbilidade/mortalidade.

Rev Port Pneumol 2007; XIII (1): 71-81

Abstract

Neoplasia-related pericardial effusions are a frequent finding and pose diagnostic and therapeutic challenges. Although they appear in the context of an underlying neoplastic disease, 50% of these effusions have a benign etiology; they are indirectly caused by the tumor. The remaining cases (neoplastic pericardial effusions – NPE) derive from extension of tumoral disease to the epi and/or pericardium and have, therefore, a worst prognosis. Despite several treatment options, the lack of apropriate guidelines difficults the evaluation of their efficacy and safety. Pericardioperitoneal shunt (PPS) is a surgical pericardial drainage method, which has demonstrated its use fulness in the management of NPE. At the CHC, this procedure is performed under videoassisted toracoscopic guidance (VATS). During the last 8 years, 18 patients have been submitted to this therapeutic option, which proved to be safe, efficacious and with low morbimortality rates.

Rev Port Pneumol 2007; XIII (1): 71-81

Palavras-chave
Derrame pericárdico, neoplasia, derivação pericardioperitoneal, drenagem pericárdica
Key-words
Pericardial effusion, neoplasia, pericardioperitoneal shunt, pericardial drainage
This article is only available in PDF
Bibliografia
1.
Guidelines on the diagnosis and management of pericardial diseases [Executive summary]
Eur Heart J, 25 (2004), pp. 587-610 http://dx.doi.org/10.1016/j.ehj.2004.02.002
2.
H.L. Porte,T.J. Janecki-Delebecq,L. Finzi,D.G. Metois,A. Millaire,A.J. Wurtz
Pericardioscopy for primary management of pericardial effusion in cancer patients
Eur J Cardiothorac Surg, 16 (1999), pp. 287-291
3.
M.A. Melfi,G.F. Menconi,A. Chella,C.A. Angeletti
The management of malignant pericardial effusions using permanently implanted devices
Eur J Cardiothorac Surg, 21 (2002), pp. 345-347
4.
J.S. Park,R. Rentschler,D. Wilbur
Surgical management of pericardial effusion in patients with malignancies
Cancer, 67 (1991), pp. 76-80
5.
M.M. De Camp,S.J. Mentzer,S.J. Swanson,D.J. Sugarbaker
Malignant effusive disease of the pleura and pericardium
Chest, 112 (1997), pp. 291S-295S
6.
K.Y. Oh,M. Shimizu,W.D. Edwards,H.D. Tazelaar,G.K. Danielson
Surgical pathology of the parietal pericardium: a study of 344 case (1993-1994)
Cardiovasc Pathol, 10 (2001), pp. 157-168
7.
C. Basso,M. Valente,A. Poletti,D. Casarotto,G. Thiene
Surgical Pathology of primary cardiac and pericardial tumors
Eur J Cardiothorac Surg, 12 (1997), pp. 730-738
8.
W.H. Warren
Malignancies involving the pericardium
Semin Thorac Cardiovasc Surg, 12 (2000), pp. 119-129
9.
P.T. Vaitkus,H.C. Herrmann,M.M. LeWinter
Treatment of malignant pericardial effusions
JAMA, 272 (1994), pp. 59-64
10.
K. Geissbühler,A. Leiser,J. Fuhrer,H.B. Ris
Videoassisted thoracoscopic pericardial fenestration for loculated or recurrent effusions
Eur J Cardiothorac Surg, 14 (1998), pp. 403-408
11.
T. Dosios,N. Theakos,D. Angouras,P. Asimacopoulos
Risk factors affecting the survival of patients with pericardial effusion subnitted to subxiphoid pericardiostomy
Chest, 124 (2003), pp. 242-246
12.
N. Wang,J.R. Feikes,T. Mogensen,E.E. Vyhmeister,L.L. Baley
Pericardioperitoneal shunt: an alternative treatment for malignant pericardial effusion
Ann Thorac Surg, 57 (1994), pp. 289-292
13.
T.J. Krause,M. Margiotta,J. Chandler
Pericadioperitoneal window for malignant pericardial effusions
Surg Gynecol Obstet, 172 (1991), pp. 487-488
14.
T.S. Tsang,J.B. Seward,M.E. Barnes,K.R. Bailey,L.J. Sinak,L.H. Urban,S.N. Hayes
Outcomes of primary and secondary treatment of pericardial effusion in patients with malignancy
Mayo Clin Proc, 75 (2000), pp. 248-253 http://dx.doi.org/10.4065/75.3.248
15.
T.F. Molnar,K. Jeyasingham
Pericardioperitoneal shunt for persistent pericadial effusions: a new drainage procedure
Ann Thorac Surg, 54 (1992), pp. 569-570
16.
K. Saatvedt,K. Nordstrand,T. Frøysaker
Pericardioperitoneal window for recurrent postoperative effusion – case report
Scand J Thor Cardiovasc Surg, 28 (1994), pp. 43-44
17.
J.E. Olson,M.B. Ryan,D.A. Blumenstock
Eleven years‘ experience with pericardioperitoneal window in the management of malignant and benign pericardial effusions
Ann Surg Oncol, 2 (1995), pp. 165-169
18.
T. Molnar,B. Biki,Ö.P. Horváth
Pericardioperitoneal Shunt: Further development of the procedure using VATS technic
Ann Thorac Surg, 74 (2002), pp. 593-595
NOTICE Undefined index: email (includes_ws/librerias/html/item.php[1239])
NOTICE Undefined index: email (includes_ws/librerias/html/item.php[1239])
Correspondência/Correspondence to: Centro Hospitalar de Coimbra (CHC) Quinta dos Vales S. Martinho do Bispo 3041-801 Coimbra (Nuno Cortesão )
Copyright © 2007. Sociedade Portuguesa de Pneumologia/SPP
Rev Port Pneumol 2007;13:71-81 - Vol. 13 Num.1 DOI: 10.1016/S0873-2159(15)30338-X
Cookies Policy
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.